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Breaking the Abuse: Using TEN-4 to Help Identify Child Abuse


Child Abuse WKLY

Abused babies in Kentucky are dying at alarming rates, according to experts.

A pediatric expert with the University of Louisville and Kosair is working to stop the violence before it becomes deadly, using “baby bruises” to spot the abuse.

Any parent will tell you that kids bruise, but Dr. Melissa Currie is teaching medical experts that certain bruises in young babies should never happen and when they do, they usually signal abuse.

She said those baby bruises are red flags helping to find abuse before it’s too late. “Bruising is the most commonly overlooked sign of abuse, especially bruising in babies,” Currie said.

Currie, chief of Kosair Charities’ division of pediatric forensic medicine, is fixated on the often tell-tale signs of abuse — bruising.

“Bruising in babies is not normal. This is not something that has been widely understood. This is new information in the medical community,” she said. “Once they start falling down, they earn their bruises in the normal locations. But young babies who are not mobile should not have bruises.”

Bruises are far too often overlooked by the medical community or explained away as accidents she said. “Even cases that seem this striking to us are dismissed as being accidental,” Currie said.

Some bruising like on a baby’s bottom is obvious. “If most of our children presented with bruises like this, we probably wouldn’t miss it as often,” Currie said. Other bruises are easy to miss.

“These bruises were seen incidentally upon exam and led to multiple broken bones being discovered,” Currie said.

Currie is teaching a method called TEN-4 — Torso, Ear and Neck (TEN) and 4, as in 4 years old and younger. “So, the examples we have on the slide here are photographs of bruising that showed up on the torso, ears and neck of a young child,” Currie said. “Any human being who looked at these photographs would be disturbed.” But they’re important photos to see to catch abuse before it’s too late.

A photo of a bruise on one baby’s torso hardly looks hazardous. “This is a very subtle single bruise on a 9-month-old baby,” Currie said. A subtle sign that the baby had been abused.

“This single bruise, had it been overlooked, would have been a missed and obvious sign of an underlying liver laceration,” Currie said.

Next, to the ear. “Any bruise to the ear, any part of the ear in a young child is a red flag,” Currie said. That’s because the ear doesn’t bruise easily. “You see bruising down in the crevasses of the ear,” Currie said.

One 7-month-old was kicked in the side of the head.

“The potential for brain damage beneath this injury is significant,” Currie said. “Beneath this injury, she did have subdural hemorrhage.”

Finally, the neck.

“This was a child with abusive head trauma who had been violently shaken,” Currie said. “We don’t know exactly what causes this. Is it the chin impacting the chest? Is it the thumbs of the perpetrator? Is it the perpetrator grabbing the face? We don’t know. What we do know is bruising in this location is not normal.”

Currie said the TEN-4 method doesn’t always indicate abuse, but it does raise red flags that the  bruises need to be checked immediately.

“It doesn’t mean it can’t be accidental, but it’s rare to be accidental and it needs to be evaluated for abuse,” Currie said. “The child’s life is at stake.”

Spotting baby bruises is crucial, but only medical experts can make that call.

If you suspect abuse, you can call 877-KY-SAFE1 (877-597-2331) or report it online.
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